Problems with ER

MunoRN, RN · Mar 18, 2015

In my state what you describe is illegal since it's patient abandonment. It would be legal so long as the nurse caring for the patient comes up with the patient and continues to care for the patient until they've transferred care to another nurse by giving them a verbal report, which is what's required in my state.

EmergencyRN22 · Mar 18, 2015

It's not safe. Is your point person or charge able take report and relay the info for you?

RyanCarolinaBoy, ADN, BSN, MSN · Mar 18, 2015

Perhaps the ER is tired of playing the "I can't take report right now" game that so many floors seem notorious for. It gets old. I work both inpt and ER. I see both sides.

jadelpn, LPN, EMT-B · Mar 18, 2015

Maybe you can have a nurse who floats the unit assisting other nurses, and that would be your admissions nurse for the shift. Backed by the charge nurse if there's more than one admission and they are coming fast and furious.

A nurse can not just come up with a patient and leave them without some type of report. Nor can they send up a patient with a transporter and just have them show up.

This is a patient safety issue. And I am curious what your risk management department would say regarding this. And that is who I would report this to.

nursej22, MSN, RN · Mar 18, 2015

This is an age old issue but IMO the root cause is understaffing: the ED is forced to push people out as their frantic schedule allows, and the floor nurses are always doing something that can't be easily interrupted.

And who suffers the consequences?

ReggieN · Mar 18, 2015

That's been part of the problem with our floor. We are terribly understaffed and overwhelmed and when we've tried explaining this to our ER they say tough. I am concerned though about patient safety. I don't feel that it's right for the Er to just send a patient up without giving a report. Are there any suggestions on how this should be handled, to make it safe for the patient

toomuchbaloney · Mar 18, 2015

Have you tried completing incident reports when the protocol for nurse to nurse report is breached and the patient is left in an unsafe situation on the floor?

imintrouble, BSN, RN · Mar 18, 2015

. It's one thing that all the nurses on the floor agree on. We stand together on this issue so it's harder to antagonize us, than to pacify the ER.

Stalling is also not done. None of us would support a nurse who didn't take report in a timely manner.

Fair is fair.

Altra, BSN, RN · Mar 19, 2015

If this is occurring with regularity, and doesn't seem to ruffle the feathers of your unit management, then this was a conscious decision for a change in process that your unit management is fully aware of. If this was not communicated to your staff, an important opportunity for education and collaboration has been missed.

Think about it: can the ER, or any other unit, unilaterally implement a change like this without some buy in from higher management?

RedSoxFan84 · Mar 19, 2015

Our policy is if the admitting nurse can't take report right away then the charge nurse has to. They will absolutely not send the patient up without report.

cheerio08 · Mar 19, 2015

Like it has already been said, this is an age old issue. I'm coming from an ER point of view, and in our hospital, we give one phone call to attempt report, either to the RN or the charge. If there is no one able to take report and the bed is ready, we fill out a paper report and the patient goes up. The nurse is free to call at any time to get report after the patient goes up. Never have I sent an unstable patient to the floor, and usually most of my inpatient orders have been started (can't speak for other nurses on this one).

The biggest difference between the ER and floors is that there is such a vast difference in priorities. You are correct in saying it is a patient safety issue. However, in the ER, we don't get to choose how many patients we get and what acuity they are. If we are pushing people onto the floor, it is usually because we want to avoid running traumas/strokes/codes in the hallwayâ€¦ Which is, as you might imagine, a patient safety issue. In the ER, our focus becomes on patient flowâ€¦ Either discharge or admit the current pt so we can get the diaphoretic chest pain out in the waiting room & in front of a doctor. I don't deny this problem stems from the ER but I also hope to shed some light on our perspective.

All that being said: I do not feel that sending a patient with no report or attempt at report is adequate. I would definitely look into ways to improve this hand off process. Leadership usually responds to staff that not only broach a problem but also offer options to solve it. Maybe bedside report would work better for your organization or maybe some sort of paper SBAR and a quick "Do you have any questions" conversation (for the stable pt) would be better. Just thoughts on what I've seen work before.